Healing Center

It's understandable that many people experiencing pain and aching in a joint because of osteoarthritis reach for the aspirin or some other conventional pain reliever. The problem is, these medications can be really rough on your stomach, and they also do nothing to slow the progress of your arthritis. Even the new COX-2 inhibitor drugs don't act to preserve the joint. At WholeHealthMD, we've found that there are other steps you can take, including the use of antioxidant supplements, to reduce cartilage degeneration and keep your joints from stiffening up.

If you have arthritis, it is important to maintain normal weight to avoid putting added stress upon bones; and adequate amounts of calcium should be consumed to prevent onset of osteoporosis. Some studies have shown that omega-3 fatty acids found in fish and flaxseed and flaxseed oil may be of benefit to those suffering from arthritis by reducing inflammation. Optimal amounts of the antioxidant vitamin, vitamin C, may be beneficial for people suffering from arthritis. Recent studies also suggest that green tea may help prevent onset of arthritis as well as reduce severity of inflammation caused by arthritis.

The most common form of arthritis is osteoarthritis, also known as degenerative joint disease. Over time, this condition produces a gradual, age-related deterioration of joint cartilage (the smooth, gel-like cushion between bones that reduces friction and absorbs shock). As the disease progresses and the cartilage continues to break down, exposed bone ends rub together and may develop growths, called spurs. When you move the joint, the spurs grind against each other causing pain and joint instability. Osteoarthritis can affect any joint, but it is most common in the fingers, knees, ankles and feet, hips, neck, and spine.

Osteoarthritis often begins gradually, with mild joint stiffness and pain that usually occur in the morning or after exercise and are relieved by rest. In some people, symptoms remain mild or even fade away. In others, however, the condition grows progressively worse and can become severely disabling. Affected joints may become deformed and gnarled. Because pain and stiffness may limit movement and exercise, the muscles surrounding the joint can become weaker, causing even more discomfort and stiffness.

Osteoarthritis is the number one cause of disability in the U.S., and now affects some 21 million Americans. By age 40, nine out of 10 people show some signs of arthritic changes on X rays, and many go on to develop joint pain and stiffness. Since osteoarthritis is part of human aging, it is neither preventable nor curable. However with attention to your health, the loss of function associated with osteoarthritis can be delayed and its symptoms can be controlled.

Osteoarthritis is different from rheumatoid arthritis, a condition in which the joint inflammation is caused by a disorder of the immune system. Rheumatoid arthritis differs from osteoarthritis in that it affects women two to three times more commonly than men. Rheumatoid arthritis is also usually diagnosed between the ages of 20 and 50, and therefore does not have a strong age-related predisposing factor. Since rheumatoid arthritis affects the tissue linings in your body, it can also cause swelling in the lining of your heart, lungs, salivary glands, and tear ducts.

Generally episodes of active rheumatoid arthritis tend to be interspersed with periods of disease remission. These â€œflare-upsâ€ can vary in severity and length. This condition is also more debilitating than osteoarthritis and carries with it more severe side effects such as depression, severe fatigue and sometime joint deformation. While there is no cure for rheumatoid arthritis you can empower yourself by choosing a strategy for joint protection, and lifestyle modification that will enable you to overcome the challenges imposed by your condition.

The breakdown of joint cartilage that characterizes osteoarthritis may be the result of years of wear and tear on the joints, but impairments in the body's ability to rebuild cartilage also seem to be involved. Other factors that play a role in the disease include genetics (osteoarthritis tends to run in families); obesity, which may increase a person's risk of developing arthritis in weight-bearing joints, such as the hips, knees, and back joints; and a congenital imperfection in joint structure.

Injury or overuse of a joint can speed up the development of osteoarthritis. This often occurs among athletes and dancers as well as people whose jobs involve constant repetitive movements, such as typists, pianists, and machinists.

Rheumatoid arthritis is caused when your white blood cells migrate from your bloodstream to your synovium (lining of your joints). Instead of battling invading bacteria and viruses, these white blood cells cause inflammation of your joint linings called synovitis. This inflammation then triggers your body to release proteins that over months or years result in the thickening of the synovium. The thickening of the synovium coupled with the wear on the cartilage, bone and surrounding tendons then leads to loss of joint shape and flexibility. Long-term these conditions cause the deformed and swollen looking joints that are one of the hallmarks of rheumatoid arthritis.

Recent research has focused on the possibility that rheumatoid arthritis is caused by an infection. Since there is a genetic component to rheumatoid arthritis, if a susceptible person was to become infected with a disease causing virus or bacterium they would thereby be more likely to exhibit the disease. This may also mean that the severity of the disease may also be hereditary. Science has only scratched the surface in discovering the direct underpinnings of rheumatoid arthritis, more postulations about its causes and its possible treatments are being formulated every day.

Conventional treatment for osteoarthritis generally falls into two categories: medication or surgery. The next section discusses the commonly prescribed drugs for osteoarthritis. Some surgical procedures that may offer relief from osteoarthritis include:

Â·Joint replacement surgery, or arthroplasty, may help to alleviate the pain and restore movement in your affected joints. The procedure involves removing the damaged joint and replacing with a plastic, ceramic, or metal prosthetic joint. Joint replacement surgery can be performed on almost any faulty joint, but the most commonly replaced joints are usually the hips and the knees. Recovery times for these operations can be about 12 weeks depending on the complexity of the procedure, and is usually accompanied by ongoing physical therapy.

Â·Arthroscopic procedures may offer some relief, however these procedures aimed at removing loose bone fragments through a small tube inserted into the affected joint, are controversial. Some studies have failed to support the clear cut benefits of arthroscopy compared with placebo. More research is necessary to gauge the short and long term effectiveness of this approach.

The next section will discuss the drugs commonly prescribed to fight rheumatoid arthritis. When afflicted by a severe form of the disease your doctor might also recommend:

Â·A procedure called prosorba column. This technique works to filter the antibodies that cause pain and inflammation from your bloodstream. This procedure is usually performed on an outpatient basis once every week for twelve weeks. This procedure is not for everyone, including those who are taking ACE inhibitors, have a history of heart disease, high blood pressure, or have insufficient clotting factor in your blood. Ask you physician what is the best course of action for your particular condition, chances are he or she will recommend a combination of medications/ supplements and a lifestyle modification plan before something as drastic as surgery.

Â·Joint replacement surgery can also be helpful in cases of rheumatoid arthritis. Here, joint replacement can help restore joint mobility, reduce pain, and also improve the outward appearance of affected joints. Again, rehabilitation times can be lengthy for this procedure, so please consult your physician to gauge all of your options before electing to undergo any surgical procedure.

There are several classes of drugs that may help to relieve the pain and inflammation caused by osteoarthritis. Among the most common are:

Â·Topical pain relievers come in many forms. You can find over the counter pain relief in creams, and ointments containing trolamine salicylate, salicylate, menthol or capsaicin, whose pain relieving properties are actually derived from the seeds of chili peppers. These preparations are most effective in treating osteoarthritis of the fingers, knees and elbows.

Â·Acetaminophen can also help to ease the pain of osteoarthritis but, it will not help to reduce the swelling of your joints. It is important to limit your alcohol intake if you regularly taking acetaminophen as this can cause liver damage. Your physician can answer any questions you have about the suitability of this treatment for your particular condition.

Â·Nonsteroidal anti-inflammatory drugs (NSAIDs) work to both relieve the pain and the swelling of arthritis sufferers. These medications can be bought over the counter or at higher strengths by prescription. Long term use of NSAIDs may cause gastric complications such as bleeding ulcers, and liver or kidney damage. Again, drinking alcohol may exacerbate this effect. You should openly discuss all concerns regarding these medications with your doctor.

Â·COX-2 inhibitors also help to control pain and relieve joint swelling without the risk of gastric malaise. COX-2 inhibitors however, are not without the risk of side effects. Prolonged use of these drugs may cause fluid retention, and high blood pressure. Recent studies link some COX-2 inhibitors to increased risk of heart attack.

Â·Antidepressants may be prescribed not only to combat the depression that often accompanies arthritis but, may also help to control chronic pain. Antidepressant medications can also help ensure that you get a restful night's sleep. Tricyclic antidepressants such as amitriptyline, nortriptyline, and trazodone.

Â·Intra-articular injections of corticosteroid may help reduce pain and swelling. Your doctor may recommend viscosupplementation, which involves injecting hyaluronic acid derivatives into the joints of the knee. This supplementation aims to replenish your joint fluid thereby cushioning your degenerating joints.

The following section details medications commonly prescribed for rheumatoid arthritis.

Â·NSAIDs, COX-2

Â·Corticosteroids may help to combat pain and slow joint damage. Among the most commonly prescribed corticosteroids are prednisone and methylprednisolone. These drugs are very effective, but can have serious side effects when taken over long periods of time. These complications include easy bruising, thinning of your bones, cataracts, weight gain, a round face, and diabetes. These medications should be taken only in the acute phase of your illness and then tapered off accordingly.

Â·Disease-modifying anti-rheumatic drugs (DMARDs) are often prescribed when rheumatoid arthritis is caught early, as this class of drugs helps prevent joint damage. Results can take anywhere from a number of weeks to months. Therefore, doctors often prescribe these drugs for use in conjunction with corticosteroids or NSAIDs to help relieve pain. TNF Blockers are a specific class of DMARDs. These drugs block TNF cell proteins that contribute to the inflammation of rheumatoid arthritis. These medications are fast acting, and can alleviate pain and swelling in as little as two weeks. However, patients with infections of any kind should not take TNF Blockers.

Â·Interleukin-1 receptor antagonist (1L-1Ra) this drug helps to prevent another inflammatory disease agent from binding and causing further damage in sensitive joints. It is administered by daily self-injection. Possible side effects of 1L-1Ra include reduced white blood cell count, headache and increased susceptibility to upper respiratory infections. Again patients suffering from unrelated infections should not take 1L-1Ra.

Â·Antidepressant drugs may help to alleviate the depression that often accompanies rheumatoid arthritis. Tricyclic antidepressants such as amitriptyline, nortriptyline, and trazodone may help alleviate pain and promote a restful sleep.

The tests and procedures employed to diagnose osteoarthritis generally fall into three categories: physical exam, blood tests, and x-rays.

Â·Physical Exam â€“ During a physical exam for osteoarthritis your physician will take a medical history. They will ask you questions o try and determine if you may have a genetic predisposition to the disease, how, where and when it affects you most, and any other confounding factors such as time of day, temperature etcâ€¦ All of these questions will help them gain a better overall understating of the extent of your complaint. This will usually be followed by palpitation/ examination of the affected joints. They will look for signs such as inflammation, swelling, or joints that are not similar in shape and size to their counterparts.

Â·Blood tests are generally performed to rule out other types of arthritis, specifically rheumatoid or reactionary arthritis.

Â·Imaging techniques used to detect osteoarthritis include x-rays of the affected joint, bone scans, CT scans, or MRIs. These tests look for signs of joint degeneration such as bone spurs, narrowed areas between joints, and reduced cartilage. These conditions may point to a diagnosis of osteoarthritis.

If you are experiencing joint pain that you think may be attributable to osteoarthritis you should schedule an exam with your physician who can perform these basic tests in his/her office. If your physician finds evidence of osteoarthritis they may refer you to an orthopedic surgeon.

The tests and procedure employed to diagnose rheumatoid arthritis generally fall into three categories: physical exam, blood tests, and x-rays.

Â·Physical Exam â€“ During a physical exam for osteoarthritis your physician will take a medical history. They will ask you questions o try and determine if you may have a genetic predisposition to the disease, how, where and when it affects you most, and any other confounding factors such as time of day, temperature etcâ€¦ All of these questions will help them gain a better overall understating of the extent of your complaint. This will usually be followed by palpitation/ examination of the affected joints. They will look for signs such as inflammation, swelling, or joints that are not similar in shape and size to their counterparts.

There is no cure for osteoarthritis, but supplements, when combined with a healthful diet, exercise, a daily stretching routine, and weight loss, can improve joint function and flexibility and perhaps even slow the progress of the disease. All these supplements (with the exception of white willow) can be used long-term, with or without conventional pain relievers such as acetaminophen or ibuprofen.

How to Take the Supplements

Start with glucosamine, following the "three-a-day" dose for up to three months, or until you get relief, then reduce to two-a-day for cost and convenience. If you're not getting the results you want, add MSM, a compound that may provide arthritis relief by delivering sulfur to arthritic joints (which studies show are low in sulfur). Although research on MSM is scant, many of my patients report good results when they combine it with glucosamine.

Either niacinamide or chondroitin can be tried if the glucosamine/MSM isn't bringing satisfactory results. Another alternative is SAMe: It works quite nicely for arthritis and many users feel an improvement in days, but it's costly.

Be patient. Repairing your cartilage takes time, so you may not see significant improvement in only a few weeks. For acute discomfort, take a conventional pain reliever such as aspirin or ibuprofen (but to lessen the chance of side effects, take it only when you need it). Or instead, try white willow, boswellia, or bromelain each has anti-inflammatory effects to reduce discomfort, but without causing the stomach distress or other side effects associated with conventional pain relievers.

As for cayenne cream, it doesn't cure a thing, but if you use it regularly, it sure can diminish the pain.

Women, men, those over 50, those with chronic illness, and vegetarians have special needs to consider when choosing a multivitamin. Review your special needs below.

Why Everyone should be Taking a Multivitamin

There's nothing like a sound, low-fat diet full of fruits, vegetables, and whole grains to supply the vitamins and minerals we need to stay healthy. Unfortunately, we don't always eat well. Add to that the possible harmful effects of stress, aging, lack of exercise, pollution and illness, and supplements become even more important. That's why so many experts now recommend that everyone take a daily multivitamin.

The Right Choice: See Our Multivitamin Chart

This chart outlines the key vitamins and minerals your multivitamin should supply and the main benefits of each nutrient. It also gives what's called the daily value (DV) - a new government standard that generally corresponds to the RDA. The DV satisfies minimum daily requirements and helps prevent a deficiency disease, such as scurvy (lack of vitamin C). The higher levels of vitamins and minerals found in many multivitamins may actually help prevent disease, delay its onset or even lessen the severity of certain ailments.

Good Reason to Take an extra-strength Formula

If you eat an optimal diet of low-fat foods, at least five servings of fruits and vegetables daily, and chicken, lean meat, or fish several times a week, you can probably get away with a once-daily formula. But even those who consume a fairly well rounded diet and yield to junk-food lapses only occasionally can benefit from an extra-strength formula. If your idea of lunch is a slice of pizza and a diet soda, look for a multivitamin in the upper ranges of our chart.

•Read the label carefully to see
what you're getting. Many "high-potency"
formulas provide only extra amounts of the less-expensive ingredients.

•Don't pay more for "timed-
released" or "related" products. They're not worth the extra cost.

• Check the serving size. You may need to swallow up to six extra-strength pills a day to get the amounts listed on the label.

•Don't double up on one-a-days You'll be getting too much of certain nutrients, and not enough of others. If you want an extra-strength formula, buy one.

• Avoid mega doses that greatly exceed the upper doses listed in our chart, especially with fat-soluble vitamins A, D, E, and K; the minerals iron and selenium; or when taking any supplements long term. Be sure to account for any vitamins and minerals you may also be taking as individual supplements or as part of an herbal formula.

Fights infections; maintains eye and skin health. May be supplied in part as beta-carotene, which may lower the risk of cancer and heart disease and boost immunity. Pregnant women should not take more than 5,000 IU of vitamin A daily, but higher doses of beta-carotene are safe.

Promotes healthy bones and teeth; may protect against cancer.Adults may be deficient even with the usual doses of 400IU in multivitamins. Those over 50 should get at least 1000 IU and those over 70 may need at least 2000 IU of Vitamin D3. Avoid daily doses exceeding 10,000 IU, which may be toxic.

400 IU

200-400 IU

may need an additional 1000IU above what is in the multivitamin. Get a Vit D blood test to determine your needs.

Prevents anemia in younger women. Men and postmenopausal women should opt for iron-free formulas. Vegetarians who avoid all animal products and women with heavy periods should get at least 18 mg a day. Don't exceed 65 mg daily.

May cure colds, relieve prostrate complaints, and slow macular degeneration. Vegetarians who avoid all animal products, including dairy and eggs, should aim to get 30 mg. Don't exceed 60 mg daily, which can be harmful.

15 mg

15 mg

15-30 mg

Special Needs

Women

of all ages need at least 1,200 mg of calcium daily, through supplements or diet, to slow bone loss. Most multivitamins don't supply this much: A separate calcium supplement is probably your best bet. Younger women, especially those with heavy menstrual periods, need plenty of iron (18 mg a day ). Those considering pregnancy should get extra folic acid and avoid high-dose vitamin A. Special "women's formulas" may contain expensive herbs you may not need.

Men

should avoid multivitamins containing iron: Iron build-up has been linked to heart disease. Be wary of "men's formulas that tout ingredients like saw palmetto for prostate complaints. Many of these high-profile "extras" are present in such small amounts that they provide little or no therapeutic benefit.

Over 50,

opt for iron-free formulas: Too much of the mineral can cause heart problems. Look for vitamins B6 and B12 in the higher ranges, because as people age, they often have trouble absorbing these nutrients. Older women and men can benefit from the bone-strengthening effects of extra calcium (1,200 mg a day) and vitamin D (400 to 600 IU a day).

Chronic Illness

can lead to poor eating habits or deplete nutrient stores. Extra-strength formulas are especially important if you suffer from a long-term digestive ailment or have liver or gallbladder problems. Consult your doctor before taking supplements.

Vegetarians

who avoid all animal foods, including dairy and egg products, need at least 100 mcg daily of vitamin B12. Zinc, iron and calcium are also very important minerals for strict vegetarians.

Disclaimer: All material provided in the WholeHealthMD website is provided for educational purposes only. Consult your physician regarding the applicability of any information provided in the WholeHealthMD website to your symptoms or medical condition.